American Society of Plastic Surgeons
For Medical Professionals
 
Dbake81
2 months ago
Answered

Insurance and Tummy Tuck.

I saw a doctor, they took pictures and asked a bunch of questions. My insurance, BCBS PPO+. This requires pre-certification. They submitted for the panniculectomy and I was approved but they refuse to submit any additional codes for approval. They will however allow me to pay the difference if I want more than a panniculectomy. I have lost over 90 lbs with diet and exercise. Why not just ask?

Procedure: Tummy Tuck
Location: Orange Park, FL

Replies 4

Gary Culbertson
ASPS Surgeon

A Tummy Tuck (TT) or Abdominoplasty are two entirely different things. They are like oranges & pineapples. A TT is a much more complicated surgical procedure that can include tightening of the abdomenial musculature, liposuction and countouring of the abdomen to produice an appealing abdominal appearance. A TT is considered to be Medically Unnecessary or a Cosmetic surgical procedure by insurance carriers. A Panniculectomy (Panni) is the simple removal of abdominal skin. These surgical procedures are two entirely different procedures and have two entirely different billing codes.

The best way to think about it just like car repair after an accident. You are driving a vintage Chevy Nova and have a wreak. The front of the vehicle needs to be fixed/ replaced. At the the auto body shop that is covered by your auto insurance company you request/ demand a Rolls Royce front end. The parts and repair codes for these cars are entirely different.

A TT is not a Panni.

Best,

G Culbertson

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Nelson Castillo

Thank you for sharing your question and congratulations on your weight loss. Unfortunately a tummy tuck is deemed not medically necessary and will not be covered by insurance. Hope this helps.

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Samir Shureih
ASPS Surgeon

You have an opinion from a very well respected TWO Board Certified Plastic Surgeons.

Been in practice for over thirty years and never had an insurance company cover an abdominoplasty.

They may pay couple of hundred dollars for a panniculectomy, which is really just removal of the hanging skin ONLY.

Based on the pictures posted and your picture animation, you seem to expect a very optimal cosmetic result, which every plastic surgeon would give you.

Panniculectomy gets rid of just the over hang skin, the cosmetic results are mediocre at best.. some commercial entities call it an ( excision), results are worthless.

Based on the pictures you may need a fleur des Lis abdominoplasty which is much involved than an abdominoplasty. Insurance will not pay for that.

Decide what you desire as final result and your questions, write them down and ask the questions at your next consult with a board Certified Plastic Surgeon. This is a two hour consult, and you pay for the consultation.

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Daniel Allan

Congratulations on your weight loss. It is a significant accomplishment and will improve your overall health. Consider yourself fortunate that your insurance company will cover the panniculectomy-they usually won't unless the pannus overhangs the pubis, which does not seem to be your situation, and have other criteria as well-chronic skin irritation resistant to treatment, documented back pain, interference with activities of daily living.

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